Prevalence of renal artery stenosis in type 2 diabetes.

Renal artery stenosis (RAS) was searched for in a Type 2 diabetes population (n =208) with severe hypertension (SHT) and/or renal deficiency (RD) and/or severe macroangiopathy (MA), using arteriography and/or duplex colour scan (with confirmation by arteriography or magnetic resonance angiography). Thirty-four (16.3 %) cases had significant RAS >=70% (83% unilateral, 17% bilateral; 11.7% with total thrombosis). High significance (P<0.01) (34 RAS vs 174 subjects without RAS) was found for male predominance (sex ratio 0.8), smoking (47%), insulin requirement (65%), prevalence and severity of decreased renal function (65%), severe hypertension (53%), and prevalence of macroangiopathy (82%), especially in association with coronary heart disease (65%). RAS prevalence was low in subjects with only 1 (8%) diagnostic criterion and high when 2 (21%) or 3 (41%) signs were present, regardless of the criterion (HT/RD/MA). A high increase of RAS prevalence was found in males, smokers and patients with heart disease or macroalbuminuria when 2 or 3 diagnostic criteria were present (no increased prevalence for only 1 criterion). RAS screening should be performed in a Type 2 diabetic population with HT, RD, or MA by opacification of the renal arteries at the same time as arteriography for control of another vessel, or by duplex colour scan when 2 or 3 diagnostic criteria are present. This attitude allows a diagnostic score of 85 % of RAS in this Type 2 diabetic population.

[Renal artery stenosis and chronic renal failure in NIDDM]. / Sténose de l'artère rénale et insuffisance rénale chronique chez le diabétique de type II.

The NIDDM patient, willingly with high blood pressure and atheroma, has frequently an abnormal renal function. Must a renal artery stenosis (RAS) be searched as a determining or favorising cause? We have searched RAS by color duplex scan, in 60 consecutive NIDDM patients with altered renal function (creatinine clearance < or = 60 mL/min). Metabolic blood pressure (ABPM), cardiovascular and renal investigations have been realised. The population was composed of 22F/38M with middle age: 70.7 +/- 6.2 yrs, diabetic duration: 11.6 +/- 8 yrs, the plasma creatinine was: 161 +/- 78 mumol/L and clearance: 40 +/- 13 mL/min. Thirty eight had albuminuria, 28 had plasma creatinine > or = 150 mumol/L. All patients had high blood pressure. Significative RAS (> or = 70%) was detected in 15 patients (25%) by color duplex scan and proved with arteriography (n = 10) or angio NMR (n = 5). Twelve (80%) had unilateral stenosis (4 thrombosis), 3 (20%) bilateral stenosis. Renal US lead the diagnosis in 10 patients (66%): unilateral or bilateral hypotrophy. Those 15 patients had these following characteristics: 4F/11M (sex R : 0.36), middle age: 70.8 +/- 7.2 yrs, diabetic duration: 14.3 +/- 7.5 yrs, HbA1c was at 8.4 +/- 2%, 8 (53%) patients require insuline and 5 have retinopathy, plasma creatinine was at 169 +/- 6 mumol/L; 32% of patients with plasma creatinine > or = 150 mumol/L had RAS (n = 9/60%), creatinine clearance was at 38 +/- 12 mL/min (7/47% < or = 30 mL/min), 9 (60%) had macroalbuminuria and 5 (33%) microalbuminuria. All hypertensive patients were treated (mean SBP: 148 +/- 16, mean DBP: 82 +/- 7 mmHg) and had 62 +/- 28% SBP escape and 33 +/- 19% DBP escape. Ten had severe hypertension (at least 3 hypotensive drugs), 12 received CEI; 8 (53%) were smokers; 14 (93%) had one or more macroangiopathies (10/66% coronary heart diseases, 7/46% lower limbs arteritis, 6/40% carotid atheroma); 13 of these macroangiopathies are severe. In conclusion, renal failure (especially evolutive and/or treated with CEI) in NIDDM must call up a RAS (25%) specially in elderly males with a long diabetes duration, severe hypertension and macroangiopathies. This patient profile must lead to a color duplex scan to confirm the diagnosis already suspected by the renal echography.

[Prevalence and profile of renovascular disease in type II diabetic patients with severe hypertension]. / Prévalence et profil d'une atteinte rénovasculaire chez le diabétique de type II hypertendu sévère.

The aim of this study was to determine the prevalence and profile of renal artery stenosis (RAS) in NIDDM population with severe hypertension. 60 consecutive NIDDM with severe HT (> or = 3 hypotensive drugs), 42 F/18 M (SR: 2.8), mean age: 66.6 +/- 6.5 years, diabetes duration: 14.1 +/- 6 years have had metabolic, ABPM and renal investigations: color duplex scan (CDS) (with renal us): n = 60, and/or arteriography: n = 17). 13 (21.5%) renal artery stenosis > or = 70%: 8 unilateral/5 bilateral were proved by arteriography. We compared classic HT (n = 47) versus renovascular HT (n = 13). There was no difference for age (years): 64.8 +/- 8 versus 70.6 +/- 6.4, HT duration (years): 11.6 +/- 6.8 versus 12.3 +/- 6. B.M.I.: 31.5 +/- 6 versus 27.6 +/- 3.3, HBA1C (%): 8.9 +/- 2.2 versus 8.8 +/- 0.9, cholesterol (mmol/L): 5.7 +/- 1.3 versus 5.5 +/- 0.6. Significant difference (p < 0.05) was noticed for S.R. (F/M): 2.9 versus 1.16, diabetes duration (years): 11.7 +/- 5 versus 16.5 +/- 8, frequency of retinopathy (%): 30 versus 61, smoking (%): 10 versus 40, triglycerides (mmol/L): 1.9 +/- 1.1 versus 2.6 +/- 1.1, and (p < 0.01) for blood pressure level (mmHg) (SBP: 142 +/- 20 vs 155 +/- 7, DBP: 81 +/- 13 vs 87 +/- 10, MBP: 103 +/- 16 vs 111 +/- 6), frequency (%) of HT escape (> or = 140/SBP, > or = 90/DBP) on ABPM: 40 versus 75 and 24 versus 40, insulin requirence (%): 36 versus 69, macroangiopathy (%): 51 versus 100 (coronaropathy: 34 vs 61, legs arteritis: 21 vs 69, carotid stenosis: 17 vs 30) and for renal function: frequency (%) of micro-macroalbuminuria: 36 versus 92 creatinaemia (mmol/L): 80 +/- 24 versus 124 +/- 44, creatinaemia clearance (mmL/min): 65 +/- 30 versus 40 +/- 12 while are found 5 renal insufficiencies (> or = 120 mmol/L). In NIDDM population with severe HT, renovascular HT is frequent (21.5%), and RAS must be evocated in unstable HT and/or renal injury with macro angiopathy, old NIDDM (> 15 years), requiring insulin. Colour duplex scan (+ renal US) mays lead to arteriography to confirm renal artery stenosis.

[Prevalence and aspects of arteriopathies in non-insulin-dependent diabetes mellitus with severe hypertension]. / Prévalence et aspects des artériopathies du diabétique non insulino-dépendant hypertendu sévère.

UNLABELLED: Severe hypertension may lead to macroangiopathy complications especially when a major vascular risk factor as diabetes exists. We have studied the prevalence of macroangiopathy in a group of 40 consecutive NIDDM patients with severe hypertension (> or = 3 hypotensive drugs) (grS) that we have compared to 80 consecutive NIDDM patients with controlled hypertension (1 or 2 hypotensive drugs) (grC). All patients have had metabolic, blood pressure (ABPM) and vascular (color duplex) investigations. The two groups were similar for age (years): 61.9 > or = 9 versus 65.2 +/- 9.5, diabetes duration (years): 10.7 +/- 7 versus 12.1 +/- 8 and hypertension duration: (years) 8.9 +/- 8 versus 11.7 +/- 7.3. The mean level of blood pressure was the same in all patients (mmHg): SBP = 138 +/- 14 versus 144 +/- 20; DBP = 80 +/- 9 versus 83 +/- 13; MBP = 100 +/- 10 versus 105 +/- 15. The frequency (%) of escape SBP (> 140): 50 versus 80, p < 0.01), and DBP (> 90): 29 versus 35, p < 0.05 was significantly higher in grS. Twenty (25%) patients in grC and 20 (50%) in grS had one or more macroangiopathy which was dispatched as follow: coronary heart disease n = 8 (7%) versus 13 (32.5%), p < 0.01; lower limb arteritis n = 12 (15%) versus n = 9 (22%), NS; carotid atheroma n = 5 (25) versus n = 6 (15%), NS. All significant renal artery stenosis (RAS) n = 8 (20%) were found in grS (p < 0.001). Only plasma triglyceride level (mmol/L) was statistically higher in grS 2.5 +/- 1.2 versus +/- 1 while BMI, plasma cholesterol, HbA1C, and creatininemia were NS. The sex-ratio (F/M) 1.28 versus 3, insulin requirement (%): 11 versus 42.5, retinopathy (%) 14 versus 45 and micromacroalbuminuria were statistically significant p < 0.01. CONCLUSION: macroangiopathy is frequent in severe hypertension (50%) versus controlled hypertension (25%) in NIDDM patients especially coronary heart disease (32.5%); the prevalence of RAS is high in grS (20%). The following criteria are frequently noticed in high risk patients: insulin requirement, micro or macroalbuminuria and high plasma triglyceride.

[Oestrogen therapy of osteoporosis (author's transl)]. / La place des oestrogènes dans l'ostéoporose.

Twenty women with physiological (11) or post-operative (9) lack of oestrogen and progesterone developed progressively painful decalcifying osteosis. Improvement was obtained (after eliminating all contra-indications) by treatment with an oestrogen (17-bêta oestradiol-14 times) associated with a progesterone (14 times ) and increased calcium and phosphates (11 times). Clinical improvement was still present after a period varying from 6 to 36 months, with disappearance of the pain symptoms in 7 cases, and very great improvement in 9 cases. After 6 months of treatment there was also a significant reduction in the biological signs of bone resorption (blood phosphorus levels, calcium-creatinine ratio in morning urine specimens taken after fasting, total calcium in a 24-hour urine specimen). The improvement noted, both clinically and biologically, confirms the effect of oestrogens in reducing bone resorption, underlines their preventive and also curative action, and makes them suitable for use in decalcifying osteosis due to hormone lack, after eliminating all contra-indications and under strict regular supervision (breasts and endometrium).

PIP: 20 postmenopausal patients with serious and painful decalcifying osteosis were treated with an association of estrogens, progesterone, calcium and phosphates. Symptomatology disappeared completely in 7 cases, and was enormously improved in 9 cases. Improvement was very rapid, beginning after only 4 weeks of treatment. 2 patients did not receive any benefit from the treatment, and 2 more had a relapse after initial improvement. Estrogen therapy does reduce bone resorption and has a definite preventive and curative action whenever there is lack of estrogens. It is imperative, however, to eliminate from this kind of treatment patients with risk of breast or endometrial cancer.

[Acquired pseudohypoparathyroidism/(PHP) in adult coeliac disease (MCA)]. / Pseudo-hypoparathyroïdie (php) acquise au cours d'une maladie coeliaque de l'adulte (mca)

One case of chronic hypocalcemia and hyperphosphatemia, with an adult coeliac disease, hight P.T.H. level, very low rate of cyclic A.M.P. in urine, and normal rate of cyclid A.M.P. in plasma is described. It is the question of the pseudohypoparathyroidism acquirec as a result of an adult coeliac disease, because of after seven months of diet without gluten the clinical and biological improvement was observed with the increase of the cyclic-AMP clearance into the normal level and its great reactivity on the administration of exogenous PTH. We think to bring an additional analysis of the trouble of renal receptivity to parathyroid hormone.

[Contribution of radioimmunologic determination of parathyroid hormone (PTH) to the diagnosis of hyperparathyroidism (HPT) (38 cases]. / Apport du dosage radioimmunologique de la parathormone (PTH) pour le diagnostic d'hyperparathyroïdie (H.P.T.) (38 cas)

The P.T.H. radioimmunoassay was done in 38 cases of suspected H.P.T. In confirmed primary H.P.T., the dosage was in positive correlation in 75% of cases; the classic metabolic exploration was in good correlation in 81% of cases. The specificity of the dosage is good but the defect of correlation comes from the antiserum utilised which recognizes the NH2-terminal region of human P.T.H.

[Radioimmunological determination of calcitonin (TCT) in the course of thyroid tumor pathology (84 cases)]. / Dosage radioimmunologique de la calcitonine (T.C.T.) au cours de la pathologie tumorale thyroidienne (84 cas)

The dosage of calcitonin was done in 13 thyroid carcinoma and 71 begnin thyroid tumors. In one case, the preoperative diagnosis of medullary thyroid carcinoma (M.T.C.) was alloved; in one another case of M.T.C. the repeatted dosage allows the evolution survey and the exploration of the family; in a third case, the dosage allows to doubt the diagnosis of M.T.C. in post-mortem. In 71 cases of begnin thyroid tumors, the calcitonin immunoassay is in the normal range. The interest and limits of the preoperative dosage was drawn of this experience.